Increasing case acceptance through communication

on 11 January 2008

In most practices, there is more dentistry sitting in the charts waiting to be done than most people actually do in their practising lives, as has been proven from decades of experience by Jameson management consultants with practices worldwide.

The main reasons people don’t accept proposed dental treatment has been proven (by Gallup Polls published by the ADA) to be a lack of dental education or no perceived need and fear of cost. So, our greatest commission as dental professionals is to become good educators!

How to communicate

We communicate by reading, writing, speaking and listening. To be an effective communicator, and therefore to gain high levels of case acceptance, you must be cognisant of all communication means. Focus all communication efforts to meet the needs of the recipient. Keep things positive, constantly affirming your purpose and mission to provide the best dental care possible. Focus on the end result and the benefits, remembering that people are always filtering what they hear or read through the ‘what’s in it for me?’ question.

Written communication must be clean and clear while serving as a reflection of the practice image. Concentrate on consistency and short, straight-forward statements that are true to your marketing or branding goals.

When communicating face-to-face, be aware of your overall image and body language. Be well dressed and well groomed. Leaning slightly toward the person to whom you are presenting will show them how alert and interested you are. Think about your tone of voice: are you monotone or is your voice interesting, dynamic and convincing?

Since 83% of learning takes place visually, 11% by hearing and the rest by the other senses, visual aids are vital if you want to communicate effectively. By visual aids, I mean before and after photos and other patient education resources. Remember, people follow your focus. So when you want them to look at your visual aid (such as the computer monitor), you need to make a point of looking that way, too. Stop to look at the patient only to assess their interest level and make eye contact. Involve as many of the senses as possible, emphasising the sense of sight above all else.

Case presentation

When it comes to case presentation, the most important aspect of effective communication is making sure you’re focusing on the needs and wants of your patient as you listen to them, read their forms and paperwork, write their treatment plan and present the case.

Remember the Boy Scout motto when it comes to verbal communication: always be prepared! Nothing extensive is necessarily required. Treatment planning is one thing, but presentation planning is also critical. Follow these three guidelines when preparing for a presentation:

1. Introduce

Tell the patient what you are going to tell them

2. Present

Tell them what you are there to tell them

3. Summarise

Tell them what you told them.

The key to their education is repetition. Speak in layman’s terms and repeat yourself to help them feel comfortable with what they’re hearing.

Questions are very powerful in helping you to understand a patient’s goals and in determining how you can meet and exceed expectations. Remember, when asking questions keep the patient involved while affirming your interest in their well-being. Honest, sincere questions may uncover objections or areas of insecurity or concern. Don’t be afraid of that, but rather face that head-on so that the patient trusts you and understands your intentions completely.

Take an objection as a great sign of interest; if a person presents an objection, they are interested in and thinking about your proposal. When preparing, try to identify a few common objections and determine effective ways to respond constructively if those are mentioned.

Identify the key motivator

I recently spoke with two dentists whose practice is doing well. They’re pursuing a way to move on to the next level as they focus on going from a good practice to a great practice and beyond. They are quite wise to recognise that, while some goals are being met and their team is skilled, there’s always room for improvement, especially in the areas of case acceptance and patient communication.

They told me a story about a potential new patient asking the practice’s business administrator if they usually stay on time. The business administrator, trying to be honest and clear, quickly answered: ‘We usually run about five to 10 minutes behind.’ The dentists asked how I would coach this team member for a more effective response to keep conversation going and eventually move into a closed sale or scheduled appointment.

It’s so easy just to answer a question before truly understanding what is being asked. Sometimes we answer a question without really knowing what’s at the core of the question in the first place. In this example, the business administrator needed to discover the key motivator of the patient so she could help address the patient’s concern with accurate information about their commitment to respecting a patient’s time.

Challenge yourself to think about the patient’s needs and motivators, not only as you present a formal case but in all your communications with one another, even as you listen. Listen carefully to everything they say as you think about what motivators may be underlying their questions and messages. This idea seems so obvious but is most often overlooked in today’s busy dental practices. Try not to answer questions with questions to the point of frustrating a potential patient. But, as appropriate, asking questions of them will make them feel like you’re really listening and caring. Let them know you’re hearing them and you’re trying to answer them with the most accurate, thorough, insightful and caring response possible.

With all of that in mind, I suggested a response similar to this: ‘It sounds like being on time is very important to you.’ Then allow the person to explain their reasons for such a concern: car-pooling co-ordination or rigid work structure, etc. Then, understanding the situation better and feeling that you indeed can accommodate their need, simply state: ‘We’ll do everything we can to make that happen for you.’

You see, some dental professionals are afraid to ask the questions these dentists posed:

• How do we close the sale?

• How do we get even better?

• What are those small differences we can ‘fine tune’ that will get dentistry out of the charts and into the mouths of those who need it?

People are hesitant to think along those lines and talk about ‘closing’ or asking patients for a commitment because they don’t want to seem pushy or too pressurising. Using effective verbal skills to get an appointment scheduled for someone who needs dental work to meet their goals is not going to be perceived as pushiness! You’re a dental professional and part of your job is to educate patients about dentistry and then to eliminate barriers until that dentistry is completed.

First of all, ask questions and then listen for the motivators. Opening questions like: ‘How can I help you?’; ‘What are your goals for your teeth, your mouth, and your smile?’; ‘What do you like most about your teeth? What do you like least about your teeth?’; and ‘If there were anything you could change about your smile, what would it be?’ are all effective in identifying motivators and helping a patient think through their goals.

For example, if the dentist asks the question: ‘If there was anything that you could change about your smile, what would that be?’, the patient may respond: ‘I really don’t like the stains on my teeth! They’re so embarrassing and I just hide my teeth as much as I can – even when I laugh or smile.’

After listening carefully and being aware of body language, the dentist could say something like: ‘So you are uncomfortable with the discolouration of your teeth, and you are interested in getting a whiter, brighter smile. Is that right?’

The dentist would need to make sure all of the patient’s concerns or goals (which usually fall within these categories: appearance, comfort, function, keeping the teeth for a lifetime, time or money) have been heard.

Once the patient confirms your understanding, the trust between the two of you is growing and, if you’ve heard all of their concerns, you know the motivators around which to build your treatment plan.

Then, present the case by covering the following key areas:

• What’s going on now?

Tell the patient exactly what the current situation is in comparison to the goals they communicated to you

• What are your expert recommendations?

Tell the patient what your proposed plan of treatment is, whether it be restoring a mouth to health or changing a smile to be more beautiful. Tell them exactly what to expect

• What are the benefits? Explain how the proposed treatment will satisfy their initial intention

• What are the disadvantages if they choose not to proceed?

When appropriate, bring any long-term considerations to the patient’s attention to help them understand both sides of the decision

• Close!

Use closing statements to identify barriers and objections. These questions call for a commitment and/or give you a chance to address any areas of concern or alleviate possible reservations so the patient can commit to making their dream smile a reality.

Here’s an example following the system. Note the constant focus on the patient’s needs and goals.

• Last week you indicated _____ is important to you. I’ve been able to design a plan of treatment around those very valid needs and wants. Your current situation, as you see on these photographs taken during your last visit, is _____. As you see in these other before photos, this patient had a very similar situation to the one you’re in now.

• After a procedure called _____, just look at the amazing difference in these after photos. I feel confident these results are very realistic for your initial goal and this could be accomplished by… […number of appointments, any key factors in the decision based on their initial goals].

• The benefits include… […a more beautiful smile with no gaps or yellowing, crooked teeth as you’ve described as ideal, a healthy mouth without disease that can be easily maintained for a lifetime, etc – any specifics regarding their situation].

• So, is there any reason not to schedule your appointment today? (If they indicate a barrier, you’ll have a chance to address that honestly and thoroughly.) Is this the treatment that will work for you? Do you have enough information to make a decision or do I need to clarify something further?

The six steps of case presentation

All of the above advice follows the six steps of case presentation.

Step one – build the relationship.

Before a person will say ‘yes’ to your recommendations, you must first build a relationship of confidence and trust.

Step two – establish the need. Ask the opening questions so you may deeply and accurately understand the patient’s attitude towards their dental health or towards the appearance of their smile so you have an accurate grasp of their perceived need.

Step three – instil the desire. Educate the patient about what is and what can be so that they understand the potential positive end results.

Step four – ask for commitment.

It is appropriate to ask for a commitment from the patient. For example, ask: ‘Have I explained the treatment so that you are comfortable with my explanation?’ If the patient responds something like, ‘Yes, I’m clear on what needs to be done,’ ask, ‘Then do you have any further questions?’. If the patient does not, say: ‘Then is there any reason why we shouldn’t go ahead and schedule an appointment to begin your treatment?’ Once your patient is ready to schedule the appointment, then you’re on to steps five and six.

Step five – financial arrangements.

Step six – scheduling the appointment.

There is no exception to this order. Financial arrangements always precede the scheduling of an appointment. We recommend the treatment co-ordinator joins the dentist while presenting the case so he/she can give necessary support for the dentist and answer questions that the patient may feel more comfortable asking someone besides the dentist, at the same time confidently presenting financial options to the patient. The dentist can say: ‘Okay, then I am going to have Jan, my treatment co-ordinator, discuss the financial responsibilities and then she will schedule your first appointment. I will look forward to working with you.’

The trust has been reaffirmed and validated, and you’re on your way to a strong dentist-patient relationship and yet another case that didn’t land in your charts!

No matter how your practice is organised, careful planning by all team members prior to the consultation will result in greater case acceptance.